The Patient Impact: Patients, Caregivers and Healthcare Providers Respond Moderated by:
Dr. Christopher Carlsten University of British Columbia
Dr. Alan Kaplan Chairperson of the Family Physician Airways Group of Canada
Joyce Yee Certified Respiratory Educator, Asthma Society of Canada
Chantale Turgeon Executive Board Member of the National Asthma Patient Alliance (NAPA)
Erika Ladouceur Executive Board Member of the National Asthma Patient Alliance (NAPA)
WITH EVERY BREATH WE TAKE! The New Air Quality Health Index (AQHI): How you can protect yourself from air pollution Alan Kaplan MD CCFP(EM) FCFP Chairperson, Family Physician Airways Group of Canada
• 14 year-old, Judy, was in ER with shortness of breath; worsening of her asthma • PMH: She has had difficult to control asthma; on – Fluticasone/ Salmeterol (Advair) Combination diskus; Salbutamol (Ventolin) prn • She is a track athlete, and was training yesterday. She does not smoke, and no-one at home smokes • What are the possible triggers for the worsening of her asthma? • Could outdoor air pollution be a trigger that is exacerbating her asthma?
Could outdoor air pollution be a trigger that is exacerbating her asthma? • Short term exposure to air pollution clearly exacerbates asthma • AQHI- asthma health care utilization “each unit increase in daily max AQHI is highly and significantly associated with an increase in asthma ED and OP visits”
AQHI
Outpatient claims
3
2278
10
3330
To, T. Ontario Lung Assoc
Short-term exposure • Exacerbation of pre-existing respiratory disease • asthma • COPD
• Exacerbation of pre-existing CVS disease • • • •
ischemia cardiac failure Arrhythmia Ischemic stroke
• Increased Hospitalization/ ED visits
Long-term exposure • • • • •
Increased mortality Increased incidence of Ca lung; pneumonia Development of atherosclerosis Pregnancy effects New onset of asthma (McConnell EHP 2010, Dell Epidemiology 2008)
• Reduced lung function growth (Gauderman NEJM 2004)
AQHI: Objectives • • • •
To create a national, simplified communications tool Measured and forecast air quality The “air pollution mixture” To empower individuals to take action to protect their health from air pollution • To create advocates for reducing pollution • To support active living
• Health effects at low pollutant concentrations • Mix of multiple pollutants • NO2 • ozone • PM2.5
www.airhealth.ca •
Many locations across the country
Health Risk Low Risk
Moderate Risk
High Risk
Very High Risk
Air Quality Health Index
Health Messages At Risk Population*
General Population
1-3
Enjoy your usual outdoor activities.
Ideal air quality for outdoor activities.
4-6
Consider reducing or rescheduling strenuous activities outdoors if you are experiencing symptoms.
No need to modify your usual outdoor activities unless you experience symptoms such as coughing and throat irritation.
7 - 10
Reduce or reschedule strenuous activities outdoors. Children and the elderly should also take it easy.
Consider reducing or rescheduling strenuous activities outdoors if you experience symptoms such as coughing and throat irritation.
Above 10
Avoid strenuous activities outdoors. Children and the elderly should also avoid outdoor physical exertion.
Reduce or reschedule strenuous activities outdoors, especially if you experience symptoms such as coughing and throat irritation.
Finding out what AQHI value affects you • Determine susceptibility (are you at-risk?) • Self Calibrate
Factors influencing dose • Time • Duration of exposure • Diurnal patterns of pollutant concentrations, outdoor activity • Activity level* • Inhalation rate • Location: Microenvironments* • Indoors • Traffic
Inhalation Rate 8 fold
6 fold
> 2 fold Source: USEPA Exposure Factors Handbook, 1997
Traffic related air pollution (TRAP) Pollutant mix •NO2 •PM: 2.5 and Ultrafine Diesel Location •In car •School bus •Exercise •150m from Highway
Could we be effective? Change in outdoor activity due to media alerts on air quality in asthmatics
Prof advice received
57%
Prof advice not received
23%
Wen XL, J Comm Health 2008
Other interventions to reduce exposure • Disease control (asthma controllers; CF) • Traffic • Exercising
• Indoor air • Intake fraction and indoor sources • Cleaning the air • HEPA filters • Air Conditioning
The AQHI is in Toronto: You can help to protect yourself from air pollution 1. Determine at risk patients 2. Tune in to the AQHI: www.airhealth.ca
3. Self calibration 4. Reduce or Reschedule strenuous activities
5. Traffic